Waynesville, North Carolina, Police Chief Bill Hollingsed said the drug death of an 18-month-old girl caused him to think about new approaches to fighting opioids. “How can you witness this ... and not say, ‘We’ve got to make a change. We’ve got to make a difference.’” (Photo by Taylor Sisk)

Could Diversion Programs Tested In Urban Areas Work for Rural, Too?

The opioid epidemic means many small towns are facing big-city problems of crime and overdoses. Two North Carolina towns are exploring a new approach – diverting some drug offenders away from prosecution and toward social-services help.

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There is no commercial district in Boiling Spring Lakes, North Carolina. There is, however, a thriving market for opioids.

Brad Shirley is chief of police for this town of 6,000, the third-largest municipality in sprawling, coastal Brunswick County, which abuts the city of Wilmington. When he arrived in January 2013, prescription painkillers and, increasingly, heroin were well established in this community.

According to the North Carolina Division of Public Health’s Injury and Violence Prevention Branch, between 2010 and 2015 North Carolina experienced an 881 percent increase in heroin overdose deaths. And between 2008 and 2013, Brunswick was among the top half-dozen of the state’s 100 counties in per capita heroin overdose deaths.

In a roughly 16-month stretch soon after Shirley took office, tiny Boiling Spring Lakes lost three lives to heroin.

Small town judicial systems are more likely than large cities to incarcerate drug offenders, according to a recent New York Times study. But Shirley began, with the assistance of the North Carolina Harm Reduction Coalition, to educate himself in alternative approaches to preventing opioid overdoses and crime. Among the initiatives he became aware of was the Law Enforcement Assisted Diversion program, or LEAD. The program launched in Seattle in 2011. It’s designed to direct low-level drug offenders away from jail and prosecution and into community-based services: treatment, housing, and more.

LEAD programs are today operating in Santa Fe, New Mexico; Albany, New York; Canton, Ohio; Huntington, West Virginia; and, most recently, Fayetteville, North Carolina.

Chief Brad Shirley (right) of the Boiling Spring Lakes, North Carolina, Police Department sent Corporal Thomas Moore to Seattle to see the Law Enforcement Diversion program in action. Boiling Springs Lakes, a town of 6,000 in eastern North Carolina, is investigating a rural version of the urban-tested program. Photo by Taylor Sisk)

In June, representatives of several rural North Carolina law enforcement agencies, including Corporal Thomas Moore of the Boiling Spring Lakes PD, traveled to Seattle to witness LEAD in action.

Shirley believes that with buy-in from all entities that must be involved, LEAD can work in rural communities such as his own. Money from the state would certainly help. District attorneys must be onboard. And a commitment from local treatment and social service providers is essential.

It’ll require communities that tend to be conservative in regards to crime and punishment to explore a radically different approach to addiction. Law enforcement officers, Shirley says, must lead the effort.

Getting people into treatment “is just common sense,” says Donnie Varnell, who formerly worked narcotics cases as a special agent in-charge with the North Carolina State Bureau of Investigation and now coordinates law enforcement initiatives for the N.C. Harm Reduction Coalition.

“You can arrest that person as many times as you want to, and they’re still going to seek another dose,” Varnell said. “Physically, they can’t help that.”

In the past couple of years, as opioid addiction has permeated communities, rural and urban, law enforcement officers have increasingly joined voices in a mantra: “We can’t arrest our way out of this problem.”

“We’ve got to change our mentality in law enforcement,” Shirley said. As the crisis mounted, he was open to new ideas.

A broken system

The first step Chief Shirley took was to equip his officers with naloxone, a drug that abruptly reverses opioid overdose. That was this past February; within a month, they had their first reversal.

LEAD struck Shirley as a logical next step.

Kris Nyrop, LEAD national support director for the Public Defender Association, said that the program was proposed in Seattle at a time when the city was at the “breaking point” in its drug problem. Nothing was working to ebb the tide; jail cells were flooded with offenders.

“Everybody agreed that the status quo was broken,” Nyrop said.

LEAD was introduced as a post-arrest, pre-booking diversion program. Those in possession of up to 7 grams of drugs or engaged in prostitution are eligible; anyone with certain prior violent offenses is not. The program has since been expanded to include “social contact” diversions, whereby officers attempt to intervene when experience advises them that a person is in imminent danger of arrest.

Officers make informed decisions – based on their familiarity with people from encounters on the street – about who’s most likely to succeed in the program. Those eligible are assigned a case manager, an advocate whose first objective is to determine what that person most immediately needs: housing, employment, drug treatment, mental health care, resolution of outstanding legal issues.

If they wind up back in trouble, they still get the help.

A study conducted by the University of Washington indicates that LEAD has been successful in Seattle. Recidivism among participants has dropped by 58 percent; they’re spending an average of 39 fewer days a year in jail. The city has saved about $8,000 a year per participant in incarceration and legal expenses, and program costs continue to drop.

Participants are also more likely to find housing – including permanent housing – and employment.

Equally important, law enforcement officers report improved relations with the people on their beats.

Since 2010 in North Carolina, deaths from prescription pain killers have held relatively steady or dropped slightly. During the same period, deaths caused by heroin increased by a factor of seven. (Graphic by North Carolina Injury & Violence Prevention Branch)

Encouraged with the success of the program, the Open Society Foundations announced in December that it would provide grants to allow seven more cities across the country, including Fayetteville, to introduce LEAD.

Magalie Lerman, a pre-booking diversion consultant for Open Society, said she believes the program can also work in rural areas – assuming there’s across-the-board buy-in – but that each community must define the specifics.

Defining moment

Bill Hollingsed, chief of police of Waynesville, a town of 10,000 in the mountains of western North Carolina’s Haywood County, remembers vividly his moment of reckoning.

Waynesville PD officers were called to an apartment where they found a dozen or so people in various stages of altered consciousness. A very small child lay on the floor, her body blue. She died before the EMTs arrived.

“This little girl was the same age as my youngest daughter when this happened,” Hollingsed said. “She was 18 months old.”

Witnesses said that the girl’s mother would crush painkillers and force them down the child’s throat to put her to sleep.

“How can you witness this,” Hollingsed asked, “and not say, ‘We’ve got to make a change. We’ve got to make a difference.’”

“I’ve been doing this for over 33 years. I’m fairly conservative; I’m big on accountability,” he said. His inclination is to think first and foremost of the victims of crimes committed by drug users.

But, he said, “If we can treat this person, and solve their addiction issues … if we get this person to stop committing crimes to fuel their addiction, ultimately we’re not only helping them, we’re helping the victims.

One of Hollingsed’s detectives, Paige Shell, was among the officers from North Carolina who traveled to Seattle to observe LEAD at work.

Hollingsed has discussed the program with the district attorney, Ashley Welch; she’s been supportive, but, like Hollingsed, is interested in seeing the early results from Fayetteville, where they’re just now enrolling their first participants.

Then there’s the question of funding. Sources say the North Carolina Department of Health and Human Services is considering LEAD among its top priorities, but no money has yet been earmarked by the Legislature.

Regardless, Hollingsed said it will be necessary to solicit support from throughout the community – the hospital, health care providers, social services, private foundations, individuals.

The program’s primary expense is paying case managers. But there must also be assurance that treatment and other services are in place.

Hollingsed said he’s talked with representatives of the area substance-abuse treatment providers, “But now we need to sit down with the directors and say, ‘OK, if the money’s not coming from the state, what can you provide from the treatment side of things?’”

He’d like to see a Haywood County-wide, interagency LEAD program in place.

Brad Shirley, on the other side of the state in Brunswick County, envisions a more localized approach that would focus on his town of Boiling Spring Lake. Brunswick County is much larger than Haywood, its jurisdictions more widely dispersed. So Shirley wants to keep the program close to home, at least initially.

Making the case

Donnie Varnell understands that a program such as LEAD may at first glance be a hard sell in rural communities. But as more and more families are roiled by addiction, and by the crimes associated with addiction, more folks may well be inclined to give it a second look. (One law enforcement officer in Brunswick County estimated that drugs figure into about 95 percent of property crimes.)

“If you can show people the statistics that back up the program,” Varnell said, “they go, ‘Yes; that makes sense. Let’s try it.’”

You attempt to slow the supply as best you can, he said, but you also need “that mechanism for treatment.

“We think that’s the LEAD program.”

Hollingsed recognizes that LEAD won’t operate in rural communities exactly as it does in Seattle. For example, allowing for possession of up to 7 grams won’t go over in Waynesville: “Our community wouldn’t go for that,” he said.

He trusts, though, that there’s a proper fit, and is certain that something more, something different, must be done.